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RAPID Trial: Therapeutic Heparin vs Prophylactic Heparin in COVID-19 Patients A study was conducted to evaluate the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with COVID-19 admitted to the hospital. Heparin has anticoagulant properties, anti-inflammatory effects and potential antiviral effects and may also improve endothelial function. Early initiation of therapeutic heparin can decrease the thrombo-inflammato...
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Prone Positioning During ECMO for ARDS There is sufficient evidence to show that prone positioning improves oxygenation and respiratory mechanics and is also associated with lower mortality in patients with moderate to severe ARDS. However, some patients can develop refractory hypoxaemia and hypercapnia that could require the use of venovenous extracorporeal membrane oxygenation (VV-ECMO) support and need to be cared for in a supine position. Hence, the physiologic...
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AKI in Critically Ill Patients With COVID-19 Acute kidney injury is highly prevalent among severely ill COVID-19 patients. However, there is very limited data on the progression of AKI and long-term outcomes in these patients. In this study, researchers aimed to describe the prevalence and risk factors for the development of acute kidney injury, its clinical course and progression and renal recovery or dialysis dependence and survival. The study was conducted...
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Ethics in Extracorporeal Life Support Extracorporeal life support has had a significant impact on modern medicine. However, the use of this technology has significant ethical challenges. In this review, the authors identify three ethical discourses: trials and evidence accompanying the use of ECLS, the ECLS allocation, decision-making and limiting care and death on ECLS and ECLS in organ donation. They then provide a narrative synthesis of all major arguments ex...
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Trends in Sepsis-Related Mortality in the U.S. Sepsis is a life-threatening organ dysfunction. It is the leading cause of death in the U.S. It is also one of the most expensive conditions to treat. However, the burden of sepsis-related mortality in the U.S. in recent years is not well-characterised. Previous studies utilise hospital databases and electronic health records to determine trends, but these have been limited to only a few hospital systems and geogr...
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Mental Disorders and Risk of Severe COVID-19 Over the last few months, several risk factors have been identified for severe COVID-19 illness and mortality. These include age, male sex, obesity and cardiovascular disease. Recent evidence from a meta-analysis also demonstrates an increased risk of severe or fatal COVID-19 among patients with a pre-existing mental disorder.  Since then, several studies have found that patients with psychiatric disorders are also ...
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Association of Higher vs Lower PEEP on Mortality Mechanical ventilation is a life-saving strategy for critically ill patients. However, it can promote and/or exacerbate lung injury through several mechanisms, including alveolar overdistension and repetitive opening and closing of the alveoli and small airways. Positive end-expiratory pressure (PEEP) has been employed to prevent end-expiratory alveolar collapse and counteract mechanical strain. However, excessive PE...
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Editorial September 29, 2021 Vasopressin and Steroids as Adjunctive Treatment for In-Hospital Cardiac Arrest Jason Haukoos, Ivor S. Douglas, Comilla Sasson JAMA. Published online September 29, 2021. doi:10.1001/jama.2021.15460 Cardiopulmonary arrest occurs in approximately 290 000 hospitalized patients annually in the United States, representing nearly 1% of all admissions and with survival estimated at 20%.1 To date, most research on cardi...
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Medical News & Perspectives October 21, 2021 The Flawed Science of Antibody Testing for SARS-CoV-2 Immunity Jennifer Abbasi JAMA. Published online October 21, 2021. doi:10.1001/jama.2021.18919 在新冠肺炎疫情大流行早期,开发商设计了新冠病毒抗体检测,以确定人们是否受到感染。一些专家认为,血液检测最终将有助于解除封锁。一种观点认为,那些带有抗体的人至少在短期内不会发生再次感染,因此他们可以回归社会,而不会使自己或他人置于危险之中。 ...
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ditorial October 21, 2021 Glucocorticoid Dose in COVID-19: Lessons for Clinical Trials During a Pandemic Steven A. Webb, Alisa M. Higgins, Colin J. McArthur JAMA. Published online October 21, 2021. doi:10.1001/jama.2021.16438 The ongoing COVID-19 pandemic necessitates an urgent need for rapid and yet methodologically rigorous clinical trials to identify the optimal combination of safe and effective treatments as well as rapid identification of c...
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